Provider Demographics
NPI:1326419888
Name:HARVEY TUCKER, CYNTHIA LYNN (BA, SUDCC III)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:HARVEY TUCKER
Suffix:
Gender:F
Credentials:BA, SUDCC III
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:HARVEY TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDCC III
Mailing Address - Street 1:8140 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3948
Mailing Address - Country:US
Mailing Address - Phone:818-582-8832
Mailing Address - Fax:
Practice Address - Street 1:8140 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3948
Practice Address - Country:US
Practice Address - Phone:818-582-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACATC - II 156155101YA0400X, 101YM0800X
225400000X
CA156155251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner